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Who should I believe????

Posted by Joe B. on 1/30/03 at 07:26 (107319)

Just saw an orthopaedic dr. who has foot and ankle disorders listed as one of his interests, along with shoulder and elbow, knees, etc. He gave me a completely different opinion for my flat feet surgery. He also sounded like he wasn't really sure what would be the correct procedure. When I mentioned the procedure that was recommended by a podiatric surgeon, he stated that he felt that it wouldn't help that much. He did give me a script for a cat scan, so that I would have it when I get different opinions.
So who should I believe?? Someone who only has an interest in foot and ankle disorders or someone who deals with foot and ankle problems on a daily basis, i.e., podiatric surgeon??? Are there orthopaedic surgeons that just do foot and ankle?? Should I still seek more opinions??

Re: Who should I believe????

Dr. Zuckermand on 1/30/03 at 11:16 (107355)

You are going to get alot of different opinions but you need to see only a foot and ankle foot specialist. Ask him or his staff when making an appointment if he is fellowhsip trained. Is this the doctor I sent you too?

Re: Who should I believe????

Joe B. on 1/30/03 at 11:26 (107358)

Yes. I just checked their website and it says that he is a member of the Association of Orthopaedic Foot and Ankle Surgeons. I just didn't have a warm and fuzzy feeling about him. Although he did give me a script for a cat scan of my feet.

Re: Who should I believe????

Dr. Z on 1/30/03 at 13:53 (107376)

I am not sure of if being a member means you are board certified or have had a fellowship in foot and ankle procedures You must feel comfortable with your doctor. After all he is going to do surgery on your foot. I have some very good podiatric board certified doctors who I could refer you too however your insurance is blocking your acess to them

Re: Who should I believe????

Joe B. on 1/30/03 at 14:39 (107380)

Do you know of any orthopaedic surgeons that only deal with foot and ankle problems?? Or do they all deal with other problems as well?? Thanks for responding.

Re: Who should I believe????

Dr. Z on 1/30/03 at 16:35 (107393)

If they are fellow-ship trained that is all they treat. I have a great foot and ankle podiatric surgeon in New Jersey. I know of a great team at the Temple School of Podiatric Medicine. It appears that you are trapped with your Aetna Insurance. I believe the Temple School is one institue you can go to

Re: Who should I believe????

Lara T on 1/30/03 at 22:15 (107437)

Even the most competent, knowledgeable doctor comes with limitations - their own biases, training, and experiences. It could be noted these limitations may also be the doctor's strength - their own biases, training and experiences.

Certainly there are some doctors we can decide are not that useful for our purposes. Either they admit they don't have the experience, or they aren't someone who's style meshes sufficiently with ours, or any number of reasons, only some of which may be related to competence. So I think seeking a 2nd, 3rd & 4th opinion makes sense - and doing research, so that you can see how their recommendation fits in to the scheme or things.

I saw two podiatrists who gave me bad advice until I found a 3rd podiatrist who was able to recognize the TTS. He recommended surgery, so I then got a 2d opinion from an orthopedic surgeon. I decided to hold off after this. IN the meantime, my neighbor who works in the medical field learned of a guy locally who is doing surgery and research in TTS so I decided to get a 3rd opinion from him. Several months later I was referred to a different orthopedic surgeon for a knee problem totally unrelated to my escapades with TTS. While there a problem had arisen with my feet and I thought maybe I could ask if they knew something since I was already there. Turns out they did know tarsal tunnel syndrome and gave me a fourth opinion (2 for surgery, 2 against surgery, 1 for diabetes and 1 for going home and stop worrying myself so much). My podiatrist has turned his practice over to a new podiatrist who also seems very knowledgeable about TTS. So now I have a fifth opinion (breaking the tie - it's now 3 against, 2 for surgery).

I don't know how doctors or insurance companies would look at seeking out
so many '2nd' opinions. I didn't get 7 opinions by design. However, by continuing to research, become knowledgeable, and keeping my ears open, I have collected more information. I can say with the exception of the doctor that diagnosed it as the beginning of diabetes (despite negative blood tests) and one that said it was in my head, all of the opinions have been helpful to me in understanding the options and the fuller picture - even though they didn't all agree. More helpful than their recommendation was their thoughts on what might have happened, and why they recommended the way they did. I would be sure to ask those questions.

Most doctors have had enough training with colds and flu, mumps, meningitis, etc that you can figure their knowledge is based on the accumulated wisdom of years of understanding passed down through generations of medical professionals. That can't be said for TTS. About 3 years ago I went to the local Med School Bookstore and went to the section on orthopedics. I found the text on Foot & Ankles, and looked up Tarsal Tunnel in the index. In this book that could probably be weighed in pounds, was at least 8-1/2' x 11', and over an inch thick, there was less than two pages on Tarsal Tunnel. It's just not been recognized long enough for standard protocols and treatments to have been passed along to the next generation of doctors.

The doctor that was doing research in surgery & TTS was perhaps the most biased and blinded by his training and experience - he seemed to me to have tunnel vision. If I was going to have surgery, he would probably have been the best, but he wasn't the best for looking at other options for treatment.

Unfortunately, it's hard to know who to believe. I was fortunate that my feet calmed down enough after getting compression socks that I had some time. I don't know if you have the same luxury. I wish it were easier - it's bad enough to have to deal with the pain of TTS.

I guess in the end, if you don't have the luxury of time, I would listen to their reasoning for their recommendation, and see how it fits with your understanding of your feet and what you learn here (or elsewhere).

Re: Who should I believe????

Joe B. on 1/31/03 at 06:28 (107457)

Does the temple team include Dr. Mahan??? If so, I have heard of him and his specialty is flat feet. Fyi, I have emailed and called Aetna concerning this Opt out of capitation procedure and both responses stated that all I need to do is just get the referral from my primary. So I may just do that and see what happens.

Re: Who should I believe????

Joe B. on 1/31/03 at 07:08 (107460)

Have you ever heard of Dr. Michael Downey???

Re: Who should I believe????

Dr. David S. Wander on 1/31/03 at 13:27 (107487)

Joe,

I believe that I answered your question regarding foot and ankle orthopedists a few weeks ago. If you want to see a foot/ankle orthopedist that performs ONLY foot and ankle surgery, I would recommend Dr. Keith Wapner/Dr. Paul Hecht at Hahnemann.

As I also previously stated, I practice in Philadelphia and I'm a past president of the Philadelphia County Podiatric Medical Societly , so I'm very familiar with the podiatric surgeons in Philadelphia.

I personally know Dr. Michael Downey and he is an EXCELLENT surgeon and I would HIGHLY recommend Dr. Downey. He is ethical and extremely competent and if I needed foot surgery, I would use Dr. Downey (I'd use myself, but that would be a little awkward!) If you are able to see Dr. Downey, it would be a great choice.

Re: Who should I believe????

Joe B. on 1/31/03 at 14:20 (107490)

Thanks for the reply, Dr. Wander. I guess I have this mental block about orthopaedic surgeons in that they are, excuse the expression, Jack of all Trades, not really specializing on one part of the body. Until now, I never heard of an orthopaedic surgeon that only performs foot and ankle surgery. So what is the difference between a podiatric surgeon and a orthopaedic surgeon that only does foot and ankle??? The way I'm starting to understand it, they should be the same except for the title.
By the way, do you know Dr. Vincent Muscarella??

Re: Who should I believe????

Ed Davis, DPM on 1/31/03 at 19:41 (107530)

Vincent Muscarella -- Temple U. School of Podiatric Medicine, class of '81 -- good man!
Ed

Re: Who should I believe????

Kay KI bee on 1/31/03 at 21:31 (107552)

I need more postive information. Too many medical ideas about this problem.

Re: Who should I believe????

Julie on 2/01/03 at 04:51 (107580)

Kay, what is your problem!? What information do you need?

Re: Who should I believe????

Dr. David S. Wander on 2/01/03 at 08:17 (107595)

Yes Joe, I know Dr. Muscarella. Why do you ask?

Re: Who should I believe????

Joe B. on 2/03/03 at 06:34 (107792)

He's my cousin, thru marriage. Can't really use him since he doesn't accept Aetna!! He's the one who initially told me what he would do to correct my problem. He also recommended Dr. Downey.

Re: Who should I believe????

Dr. Zuckermand on 1/30/03 at 11:16 (107355)

You are going to get alot of different opinions but you need to see only a foot and ankle foot specialist. Ask him or his staff when making an appointment if he is fellowhsip trained. Is this the doctor I sent you too?

Re: Who should I believe????

Joe B. on 1/30/03 at 11:26 (107358)

Yes. I just checked their website and it says that he is a member of the Association of Orthopaedic Foot and Ankle Surgeons. I just didn't have a warm and fuzzy feeling about him. Although he did give me a script for a cat scan of my feet.

Re: Who should I believe????

Dr. Z on 1/30/03 at 13:53 (107376)

I am not sure of if being a member means you are board certified or have had a fellowship in foot and ankle procedures You must feel comfortable with your doctor. After all he is going to do surgery on your foot. I have some very good podiatric board certified doctors who I could refer you too however your insurance is blocking your acess to them

Re: Who should I believe????

Joe B. on 1/30/03 at 14:39 (107380)

Do you know of any orthopaedic surgeons that only deal with foot and ankle problems?? Or do they all deal with other problems as well?? Thanks for responding.

Re: Who should I believe????

Dr. Z on 1/30/03 at 16:35 (107393)

If they are fellow-ship trained that is all they treat. I have a great foot and ankle podiatric surgeon in New Jersey. I know of a great team at the Temple School of Podiatric Medicine. It appears that you are trapped with your Aetna Insurance. I believe the Temple School is one institue you can go to

Re: Who should I believe????

Lara T on 1/30/03 at 22:15 (107437)

Even the most competent, knowledgeable doctor comes with limitations - their own biases, training, and experiences. It could be noted these limitations may also be the doctor's strength - their own biases, training and experiences.

Certainly there are some doctors we can decide are not that useful for our purposes. Either they admit they don't have the experience, or they aren't someone who's style meshes sufficiently with ours, or any number of reasons, only some of which may be related to competence. So I think seeking a 2nd, 3rd & 4th opinion makes sense - and doing research, so that you can see how their recommendation fits in to the scheme or things.

I saw two podiatrists who gave me bad advice until I found a 3rd podiatrist who was able to recognize the TTS. He recommended surgery, so I then got a 2d opinion from an orthopedic surgeon. I decided to hold off after this. IN the meantime, my neighbor who works in the medical field learned of a guy locally who is doing surgery and research in TTS so I decided to get a 3rd opinion from him. Several months later I was referred to a different orthopedic surgeon for a knee problem totally unrelated to my escapades with TTS. While there a problem had arisen with my feet and I thought maybe I could ask if they knew something since I was already there. Turns out they did know tarsal tunnel syndrome and gave me a fourth opinion (2 for surgery, 2 against surgery, 1 for diabetes and 1 for going home and stop worrying myself so much). My podiatrist has turned his practice over to a new podiatrist who also seems very knowledgeable about TTS. So now I have a fifth opinion (breaking the tie - it's now 3 against, 2 for surgery).

I don't know how doctors or insurance companies would look at seeking out
so many '2nd' opinions. I didn't get 7 opinions by design. However, by continuing to research, become knowledgeable, and keeping my ears open, I have collected more information. I can say with the exception of the doctor that diagnosed it as the beginning of diabetes (despite negative blood tests) and one that said it was in my head, all of the opinions have been helpful to me in understanding the options and the fuller picture - even though they didn't all agree. More helpful than their recommendation was their thoughts on what might have happened, and why they recommended the way they did. I would be sure to ask those questions.

Most doctors have had enough training with colds and flu, mumps, meningitis, etc that you can figure their knowledge is based on the accumulated wisdom of years of understanding passed down through generations of medical professionals. That can't be said for TTS. About 3 years ago I went to the local Med School Bookstore and went to the section on orthopedics. I found the text on Foot & Ankles, and looked up Tarsal Tunnel in the index. In this book that could probably be weighed in pounds, was at least 8-1/2' x 11', and over an inch thick, there was less than two pages on Tarsal Tunnel. It's just not been recognized long enough for standard protocols and treatments to have been passed along to the next generation of doctors.

The doctor that was doing research in surgery & TTS was perhaps the most biased and blinded by his training and experience - he seemed to me to have tunnel vision. If I was going to have surgery, he would probably have been the best, but he wasn't the best for looking at other options for treatment.

Unfortunately, it's hard to know who to believe. I was fortunate that my feet calmed down enough after getting compression socks that I had some time. I don't know if you have the same luxury. I wish it were easier - it's bad enough to have to deal with the pain of TTS.

I guess in the end, if you don't have the luxury of time, I would listen to their reasoning for their recommendation, and see how it fits with your understanding of your feet and what you learn here (or elsewhere).

Re: Who should I believe????

Joe B. on 1/31/03 at 06:28 (107457)

Does the temple team include Dr. Mahan??? If so, I have heard of him and his specialty is flat feet. Fyi, I have emailed and called Aetna concerning this Opt out of capitation procedure and both responses stated that all I need to do is just get the referral from my primary. So I may just do that and see what happens.

Re: Who should I believe????

Joe B. on 1/31/03 at 07:08 (107460)

Have you ever heard of Dr. Michael Downey???

Re: Who should I believe????

Dr. David S. Wander on 1/31/03 at 13:27 (107487)

Joe,

I believe that I answered your question regarding foot and ankle orthopedists a few weeks ago. If you want to see a foot/ankle orthopedist that performs ONLY foot and ankle surgery, I would recommend Dr. Keith Wapner/Dr. Paul Hecht at Hahnemann.

As I also previously stated, I practice in Philadelphia and I'm a past president of the Philadelphia County Podiatric Medical Societly , so I'm very familiar with the podiatric surgeons in Philadelphia.

I personally know Dr. Michael Downey and he is an EXCELLENT surgeon and I would HIGHLY recommend Dr. Downey. He is ethical and extremely competent and if I needed foot surgery, I would use Dr. Downey (I'd use myself, but that would be a little awkward!) If you are able to see Dr. Downey, it would be a great choice.

Re: Who should I believe????

Joe B. on 1/31/03 at 14:20 (107490)

Thanks for the reply, Dr. Wander. I guess I have this mental block about orthopaedic surgeons in that they are, excuse the expression, Jack of all Trades, not really specializing on one part of the body. Until now, I never heard of an orthopaedic surgeon that only performs foot and ankle surgery. So what is the difference between a podiatric surgeon and a orthopaedic surgeon that only does foot and ankle??? The way I'm starting to understand it, they should be the same except for the title.
By the way, do you know Dr. Vincent Muscarella??

Re: Who should I believe????

Ed Davis, DPM on 1/31/03 at 19:41 (107530)

Vincent Muscarella -- Temple U. School of Podiatric Medicine, class of '81 -- good man!
Ed

Re: Who should I believe????

Kay KI bee on 1/31/03 at 21:31 (107552)

I need more postive information. Too many medical ideas about this problem.

Re: Who should I believe????

Julie on 2/01/03 at 04:51 (107580)

Kay, what is your problem!? What information do you need?

Re: Who should I believe????

Dr. David S. Wander on 2/01/03 at 08:17 (107595)

Yes Joe, I know Dr. Muscarella. Why do you ask?

Re: Who should I believe????

Joe B. on 2/03/03 at 06:34 (107792)

He's my cousin, thru marriage. Can't really use him since he doesn't accept Aetna!! He's the one who initially told me what he would do to correct my problem. He also recommended Dr. Downey.